Acute
arterial occlusion resulting in limb
ischemia may be caused by a diverse array of conditions but most often is the result of an arterial
embolism or
thrombosis of a previously diseased vessel. Differentiation of these two primary entities may be difficult, but a careful history, thorough physical examination, and liberal use of arteriography can usually separate them. Distinction is important because an
embolus is almost always best treated by prompt operation, whereas management of acute arterial
thrombosis is often improved when the limb is viable, and emergency operation can be deferred. The significant underlying cardiac problems responsible for an
embolus continue to cause appreciable morbidity and mortality after arterial
embolectomy despite simplification in the operative procedure itself and steady improvement in
limb salvage. Although the risk of emergency surgical treatment of acute arterial
thrombosis is usually less than that associated with
embolectomy, results of salvage of the limb are often less satisfactory. Nonoperative management of acute
ischemia by high-dose antiocoagulation alone or use of
fibrinolytic drugs may also be useful in specific circumstances. Exact indications for the use and likely benefits of such nonoperative
therapy remain unsettled.